MEDICARE: LOAN HUYNH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	59098	CA

General Provider Information

NPI Number	:	1922320126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOAN HUYNH

Provider Business Mailing Address
First Line	:	388 E OCEAN BLVD UNIT 1007
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5269
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1806
Country	:	US
Telephone Number	:	480-375-5815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2010
Last Update Date	:	02/23/2010

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Directions to “ LOAN HUYNH ” Practice Location

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